JOHANNESBURG – Initiation ceremonies in South Africa have led to the deaths of 60 young men and the hospitalization of hundreds since May, sparking concern from officials about regulations surrounding a national tradition that determines when a boy becomes a man.

Health minister Aaron Motsoaledi says the most recent deaths in the Eastern Cape province were caused by illegal schools that have undermined cultural traditions in the country.

Thirty initiates died within the month and 300 young men were also hospitalized, a government health spokesman said this week. Ten of those young men were rescued with badly scarred genitals from botched circumcisions.

Initiation ceremonies are common in some South African cultures as a rite of passage into adulthood. Young men undergo circumcision and are exposed to near-freezing winter conditions with little clothing.